Two rhinoplasties, deviated tip, higher right nostril — best revision options? (Photos)

Question

Hello, I have had two rhinoplasties. The first over‑resected my alar cartilage, the second used a septal extension graft, an alar rim graft, a right spreader graft, and a right columellar graft. The right side feels rigid, my tip deviates, and my right alar rim sits higher; I want a natural, symmetric nose with a centered tip. Could a conservative revision of the right soft triangle lower the rim in frontal view without notching? Would careful contouring or shaving of the right‑sided grafts or cartilage help, or might it risk further retraction? Should I reposition or replace the alar rim graft, or consider an additional alar or composite graft to lower and support the rim? Could adjusting the septal extension graft and the tip sutures help recenter the tip? Would you treat this as a minor touch‑up or a full revision, and when would you operate? Thank you very much.

Philip S. Schoenfeld, MD, FACS · Answer

The appearance of your nose is not perfect, but it is definitely does not draw attention.  Undertaking a third revision is likely going to require reconstruction of the lateral crura and soft triangle. There is no guarantee that this will completely lower the alar rim and a composite graft may also be required to address this area appropriately.  From a non critical evaluation of your face, your nose does not detract from your appearance so be cautious about undertaking a third surgery.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your description and partial photographs, you may benefit from a revision rhinoplasty. A surgeon can accomplish this by tensioning the tip and placement of extended alar contour grafts. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Eric M. Joseph, MD · Answer

Based on what we see, you have asymmetrical nostril margins, and the left side is higher than the right. Permanent non-surgical nose job treatments utilizing microdroplet Silikon-1000 may be considered for improving upon your nostril symmetry, and for decreasing your nostril show on both sides. I hope this helps! Sincerely, Dr Joseph

Alejandro Nogueira, MD · Answer

Yes, probably you got great benefit from that second surgery to revision the results, however, it is beyond me why the surgeon did not encompass the whole caudal area of the nose within his re-structuring, failing to do so leads to issues like yours.

Unfortunately this is not a case for a small procedure, would be repeating the same mistake, you need a comprehensive and total re-structuring of the tip-alae-columella complex so that you obtain aesthetic and subjective sensation symmetry.

Seek the advice and hands of a unfrightened surgeon who feels comfortable disassembling / reassembling noses, that's the core of your technical needs now.

REVISION RHINOPLASTY PROVIDERS NEAR YOU

Two rhinoplasties, deviated tip, higher right nostril — best revision options? (Photos)

Answers (4)

REVISION RHINOPLASTY PROVIDERS NEAR YOU